Macrophage regulation of vitamin D3 metabolites.
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Calcitriol↗
Biomedical subjects
J Steele
Publications and source records attributed to J Steele.
Critical care voices: required request organ donation.
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Critical Care↗
The development and evaluation of lighten up, an Australian community-based weight management program.
UNLABELLED: Programs of widely ranging size were conducted successfully in seven localities and thus the program was considered an operational success. The reductions in weight, blood pressure, and waist and hip measurements observed at the 3-month follow-up compared well with reports of other community-based programs. Almost all participants evaluated the program highly and reported positive changes in behaviors related to food and exercise. Qualitative data indicate that the coordinators developed a sense of ownership of the program--which will be vital to its sustainability. Rapport between coordinators and participants was more easily established in smaller programs than in larger ones and was an important underlying determinant of retention rates. SIGNIFICANCE: The Lighten Up program integrates environmental and individual strategies to facilitate changes towards a positive, lifestyle approach to long-term weight management. The program aims to establish sustainable social support networks with effective links to health services. This study has demonstrated that, with appropriate training and resources, existing public sector, primary health care personnel with no previous experience in health promotion can implement the program successfully in several communities concurrently. In the Australian context, this program can play an important role as one strategy in a range of interventions required to address the issue of obesity. The stepped-care model described by Brownell proposes that program options of varying intensity, and thus cost, be available to meet the variety of needs of overweight people who wish to lose weight. The Lighten Up program was close to the midpoint of that range in that it combined population strategies with one-on-one contact with health care personnel. LIMITATIONS: Participants in the study were self-selected people who had acted quickly to enroll in the program, and it is therefore likely that the sample was overrepresented with early adopters who may have been more successful than others would have been. We cannot tell from this developmental study whether or not the program will appeal to population groups known to be at high risk for obesity. This is an important question that needs to be addressed in future research. No control group was included in the design and thus we cannot be sure the benefits experienced by the participants resulted from the program. However, process evaluation data indicate that nothing that might explain the findings, other than the program, occurred in the communities during the time of the study. Further important issues to be evaluated include: the long-term maintenance of weight loss; whether or not the program will reach targeted populations, particularly groups of low socioeconomic status; and the extent to which the public health staff will maintain enthusiasm for the training and the programs.
Adult↗
Leading the way with community health partnerships.
In this era of shrinking resources and decreasing reimbursement, the notion of universal healthcare may seem more implausible than ever before. Yet it turns out that this goal is not so far-fetched. A driving force behind this realization is Marilyn Gaston, M.D., U.S. assistant surgeon general and director of the Health Resources and Services Administration's Bureau of Primary Health Care. Several years ago Gaston began asserting that universal healthcare was a realistic goal. To those who protested that this was an unachievable dream, Gaston responded that because she had seen some communities achieve it, she knew every community could.
Community Health Planning↗
Impact of medical examiner/coroner practices on organ recovery in the United States.
OBJECTIVE: The object of this research is to determine the nature and extent of the loss of donor organs during a 3-year period that are otherwise medically suitable for organ transplantation owing to nonrelease by a local medical examiner or coroner. DESIGN AND DATA SOURCES: In a retrospective study of the effects of medical examiner/coroner donor release practices, a detailed survey was mailed to every organ procurement organization (OPO) in the United States. This survey collected specific data (eg, number of cases denied per year), as well as descriptive information. RESULTS: Of the 2670 organ donors reported by 39 OPO respondents in 1990, 62.1% were medical examiner cases, and 129 (7.2%) of these cases were denied recovery by the local medical examiner/coroner. The number of denials increased to 181 (9.6% of medical examiner cases) in 1991 and to 251 (11.4% of medical examiner cases) in 1992. It is estimated that the population of medical examiner/coroner denials from 1990 through 1992 may be as many as 884. Twenty percent of the OPO respondents reported that no cases were denied recovery by a local medical examiner/coroner. A comparative analysis reveals that the proportion of total reported potential medical examiner/coroner cases that were denied increased by 65% from 1990 to 1992, while medical examiner/coroner cases released declined slightly. CONCLUSIONS: Since an average of 3.37 organs were recovered per donor in 1992, it is possible that as many as 2979 people may have been denied transplants from 1990 through 1992 owing to medical examiners'/coroners' denials. There were no donor denials in 10 geographical areas of the United States, nor was there any instance of violation of case law or any documentation of flawed autopsies or collection of forensic evidence in donor cases released. These two factors suggest that the loss of human life from denials is not needed to protect the judicial process. Increased cooperation between medical examiner offices and OPOs could significantly increase the availability of transplantable organs.
Coroners and Medical Examiners↗